Give women more time to give birth, make choices - WHO

GENEVA (Reuters) - Women in labour should be given more time to give birth and have fewer medical interventions, while participating more in decision-making, the World Health Organization (WHO) said on Thursday.

Among 26 new recommendations, it rejected a traditional benchmark in labour wards worldwide for the dilation of a woman’s cervix at the rate of 1 centimetre per hour, saying it was “unrealistic” and often led to excessive caesarean sections.

“What has been happening over the last two decades is that we are having more and more interventions being applied unnecessarily to women,” said Dr. Olufemi Oladapo, a medical officer in WHO’s department of reproductive health and research.

“Things like caesarean sections, using a drug called oxytocin to speed up labour is becoming very rampant in several areas of the world,” he told a briefing.He was referring to the synthesised form of a natural hormone routinely injected intravenously to women to cause contractions, expediting birth to avoid complications.

In the 1950s, American obstetrician Emanuel Friedman studied the progression of labour and laid down a guideline that a woman’s cervix should dilate at the rate of 1 cm per hour in the initial stage.

But research in the past 15 years, including a WHO study of 10,000 women in Nigeria and Uganda, has shown the rate can be slower without endangering the health of a woman or child, Oladapo said.

“It’s not a good benchmark, it’s not a one-size-fits-all kind of thing. We feel that everybody is unique, and some women can go slower than that and still have a normal vaginal birth.”

A better threshold is 5 cm of dilation during the first 12 hours for a new mother and 10 hours in subsequent labours, WHO said. A woman’s vital signs and baby’s heartbeat should be monitored closely throughout.

Caesarian rates of more than 10-15 percent do not appear to lead to any significant drop in mortality rates of mother or child, said WHO’s Metin Gülmezoglu.

Among middle-income economies, Latin America, Turkey, China and Iran have high caesarean rates, but so do some hospitals in sub-Saharan Africa, “and often not for the right reasons”, he said.

Women should be allowed to choose their delivery position,, including squatting or sitting, and be offered pain relief, Oladapo said.

“We want a situation where women have an informed choice, and they are involved in decision-making,” he said.

Episiotomy, a cut made to the woman’s outer genital area to widen the birth canal, is not recommended routinely. “If anything it actually does more harm than good,” he said.